An Assessment of Digital Media-related Admissions in Psychiatrically Hospitalized Adolescents

What methods are used in research of firsthand experiences with online self-harming and suicidal behavior? A scoping review

BACKGROUND

Online self-harming and suicidal behavior is a novel and rapidly increasing phenomenon warranting comprehensive mapping of used research methods.

AIM

To identify and map how knowledge on online self-harming and suicidal behavior is gathered, including how data are collected e.g. questionnaires and interviews.

METHODS

The review follows the Joanna Briggs Institute Manual for Scoping Reviews in tandem with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A keyword search of three electronic databases was conducted on two occasions, yielding 5422 records. Following duplicate removal, the records were screened based on the following inclusion criterions; (1) in English or Nordic language and published between 2011-2022, (2) presenting results for self-harming and/or suicidal behavior on social media and (3) using tools for either interview or questionnaire aiming at assessment of the experience of online self-harming and suicidal behavior from the perspective of the person who engages in the behavior. A total of 64 articles were included.

RESULTS

45 used questionnaires, 17 used interviews, and two studies mixed the two approaches. 17% of the studies had made some effort to ensure validity within the questionnaires and 15.8% gave full access to the interview guide.

CONCLUSION

Research into online self-harming and suicidal behavior is characterized by a lack of validated measurements and methodological transparency. The results emphasize a need for further development, testing, and validation of questionnaires and greater openness and reflexivity in qualitative methodology to enable cross-study comparison and advance knowledge of this complex phenomenon.

Cyberbullying and Non-Suicidal Self-Injury (NSSI) in Adolescence: Exploring Moderators and Mediators through a Systematic Review

(1) Objective: This systematic review explores the intricate relationship between cyberbullying and non-suicidal self-injury (NSSI) in adolescents, acknowledging the dynamic nature of these phenomena in the evolving landscape of technology and social norms. (2) Methods: PubMed/MEDLINE, Web of Science, and EMBASE were searched, and 14 studies were selected based on the eligibility criteria, focusing on participants aged 10 to 19, cyberbullying roles, and NSSI as the predictor and outcome variables, respectively. (3) Results: Internalizing symptoms, specifically depression and anxiety, emerged as the most prominent mediators. However, factors such as externalizing symptoms, stress, and negative emotional responses (emotion reactivity, negative emotions) were also identified to play a significant role in the relationship between cyberbullying and NSSI. On the other hand, protective factors against the negative impact of cyberbullying on NSSI risk, such as strong peer connections and school engagement, were identified. (4) Discussions: This review underscores the multidimensional nature of the cyberbullying-NSSI association, emphasizing the roles of potential risk factors such as internalizing and externalizing symptoms, stress, and negative emotional response. Internalizing symptoms played a central role as pathways between cyberbullying victimization and NSSI. Additionally, social factors, including peer connections and school engagement, were found to act as protective elements. (4) Conclusion: Continuous investigation is crucial in order to adapt interventions to the evolving technological and social landscape. The study advocates for targeted interventions that prioritize positive social connections to mitigate the impact of cyberbullying on adolescent well-being.

Digital Media-related Problems Contributing to Psychiatric Hospitalizations Among Children and Adolescents Before and After the Onset of the COVID-19 Pandemic

The role of digital media in crises leading to youth psychiatric admissions is understudied and digital media use increased during the COVID-19 pandemic. In this cross-sectional study, demographics, clinical characteristics, and digital media-related problems (DMRPs; sub-coded as cyberbullying, online communication problems, triggering content, and limit-setting problems) were extracted from hospital records of youth (n = 1,101) admitted to a pediatric psychiatric unit from May 2018 to November 2021. DMRPs were identified in 127 admissions (11.5%), led by the online communication problems and limit-setting subtypes (both 4-5%). Significantly more overall problems were identified following the pandemic onset (13.9% of admissions vs. 9.1% before, p < 0.05). The limit-setting subtype specifically increased post-COVID-19 (6.0% vs. 2.7%, p < 0.01), and was associated with prior admissions, suicide attempts, and impulse control/behavioral disorders. Online communication problems were significantly more common among girls and youth with a history of trauma. Interventions in acute settings to mitigate consequences of DMRPs are needed.

Review: Digital experiences and their impact on the lives of adolescents with pre-existing anxiety, depression, eating and nonsuicidal self-injury conditions - a systematic review

BACKGROUND

Published systematic reviews provide evidence linking positive and negative digital experiences to adolescent mental health. However, these reviews focus on the general public rather than the digital experiences of adolescents with different pre-existing mental health conditions and so may be limited in their clinical relevance. We review publications relating to anxiety, depression, eating disorders and nonsuicidal self-injury to identify common and condition-specific digital experiences and how these may be implicated in the origins and maintenance of these mental health conditions.

METHODS

A systematic literature search using a combination of mental health, digital experience (including social media use), and age of the target population terms was conducted on four databases. Detailed findings from the included studies were summarised using a combination of thematic and narrative methods.

RESULTS

Five qualitative and 21 quantitative studies met the eligibility criteria for inclusion (n = 5021). Nine studies included adolescents with depression, one with eating problems, two with nonsuicidal self-injury and 14 with multiple emotional health conditions. The review identified six themes related to the target populations' digital experiences: (a) social connectivity and peer support; (b) escape and/or distraction; (c) social validation and social comparison; (d) accessing/creation of potentially harmful content; (e) cyberbullying; and (f) difficulties with self-regulation during engagement with digital media.

CONCLUSIONS

Digital practices of adolescents with pre-existing clinical vulnerabilities are complex and encompass a range of positive and negative experiences, which appear to have common elements across different clinical populations. The literature is currently too limited to identify disorder-specific practices, with too few direct or indirect comparisons between conditions.

Digital media-related precursors to psychiatric hospitalization among youth

Digital media, including smartphones and social media, are central in youths' lives. This study aimed to examine the role of digital media in psychiatric hospital admissions among adolescents. 343 psychiatrically-hospitalized youth (Mage = 15.2; 70.3% White, 13.7% Black, 33.9% Hispanic; 48.7% female) completed self-report measures of potential digital media-related reasons for hospitalization, patterns of digital media use, and clinical symptoms (internalizing, externalizing, suicidal ideation and attempts). Digital media-related reasons for hospitalization were common, with over 40% of the sample endorsing at least one such reason; 24.8% endorsed having their phone taken away as a reason for admission. Younger adolescents and youth with addictive patterns of phone use were more likely to endorse digital media-related reasons for hospitalization, including phone restriction and negative social media experiences. In addition, youth endorsing suicide-related social media engagement (e.g., posting or messaging about suicide) as a precursor to admission reported more severe suicidal ideation and greater likelihood of a recent suicide attempt. Limitations of the study include a reliance on self-report measures and cross-sectional design. Findings highlight the need to identify youth who may be especially vulnerable to digital media experiences that contribute to risk for psychiatric hospitalization.

Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study

BACKGROUND

Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many "in-person" coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use.

OBJECTIVE

This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population.

METHODS

The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple's daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores.

RESULTS

A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization.

CONCLUSIONS

Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU.